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CITY OF TIGARD
CE:RTIF'ICN7'E OF M
e COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY
13125 SW Hall Blvd.Tigwd,O;®pon 97223.8109 (5031,A�,"171 PERMIT #. . . . . . . a MST93-95911
639_•4171 DATE ISSUEDc 03/07/94
SITE: Fll)DFtET.3. . .. : 08536 SW Mf RLYNE: C'T
SUBDIVIS ON. . . . I FINLEY PARF4 Z(.)NINGvP- 7
BLOCK. . . . . . „ . . . a LOT. . . . . . . . . . . . . 1004 �
CI-ASS Cly= WC2f215. :NEW _.... _. _._.w_. ...__._._,..._.._..._ .__...,,.__....._._.._..__._.._.__........_.,.__.____.._.,.
TYPE OF USE. —OF
OF
OCCUPANCY GRP. .R3 w
' OCCUPANCY 1.-OAD a 1 16 4
TENANT NE1ME. . . a
Remarks - PATH H
Owner ___.._._..._.._..........._.._. .._.....__..___. ...._...._ _
TIM MILLER
13t1r z 7 I;aW T I MARA LN
T IOARD 013 9- 7224
Phone #o 598...8'17.4
Contractor 1 _. . ...._ _ _....._.._ _._ . ._.. ..
'rim MILLC R
130i?7 SW T'IMARA LN
T I( ARD OR 97224 M
Ph011e #3 598-•-8574
Rog #. . s 64687
(..lCcUPanr..yt of the above referenced is hereby Niven, and c ertifiea
the c_umplianc.,e with the gt�atu Of Oregon "Specialty Codes for t:hW group,
f3cc.rpnnLy, a#nd arse Wncidrr which the r-cafarenced permit w.as issuecl.
F,RE UEC'AFtTME�NT _..._ _ ._._.,_._.._ .:�` � .•I._ Ih ' NSF�'E::C: T'17F7
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LD FFIC.,IAL
POST IN CONVP I I:UOUS 17,L-Pf7F
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INSPECTION NOTIM �
City of Tigard Iwilding Department
13123 SR Hall Blvd. Tigard, Orogen 97 ,'�.
Inspection Line (Rec-O-Phone): 639-4175 Businessil.T639-4173
Inspection:,. ___
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing �-•Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb 11
Plbg. Underfloor Water Line Gyp. Rd. =-M—h.
Dare Requested:// � G� I Time: f1M �j �•� t A
Address: Y) ,l1 1' w V IL.Q -^ Perish #t�h2 1 I /
Builder.: Z QD(p
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector., -� ---- Date:_ =—/
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APPROVED DISAPPROVED APPROVED SUBJECT TO
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_— -Call For Reinap.
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INSPECTION NOTI
City of Tigard Building
..3125 SN Ball Blvd_ Tigard, v ogon 97 23
Inspection Line (Rec-O-Phone): 639-4175 Business one: 639-4171
Inspection:___�_�---.—.�--_�—r—_—_ _____---------- -----
tooting Plbg. Underslab Mech. Rougf -in Appr/Sdwlk
Pound. Plbo. Top Out Gas Line PINALs
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Poet/Beam Struct. San. Sewer Framing -Bldg. x
hast/Beam Mech. Rain Drain Insulation -Plumb
Plbg. Underfloor Water Line Gyp. Bd. -Mech. //
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Date Requested: �/� ���j LI Timet �AM C CPM�j
Address-4e
ddress•_be7 , f `�V�l� V• C� Permit #e 1\/kr7T 13- /-)
Builders
THE POMMAINO CORRECTIONS ARE REQUIRED:
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Inspector:
APPROVEb DISAPP:tOVEU APPROVED SUBJECT TO ABOVE
____-Call Por Reinap.
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INSPECTION NOTICE
City of Tigard Building Depart ent.
13125 SW Wall Blvd. Tigard, Oregon 97223 _
Inspertion Line (Ree-O Phone): 639-4175 Business Phone: 639-4171
Footing Plbg. Underalab Mech. Rough-in CAPPr/gdwlk y�
Found. Plbg. Top Out Gas Line
FINAL-
Post/Beam
=pu ;Poet/Beam Struct. San. Sewer
Framing gldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb. --
Plbg. Underfloor Water Line / Gyp. Bd. -Mech.
Date Roqueated: �) Z `�11 N —Tip�t AM _PM
/ v
Address: �lC `(.1�
E Permit 1:�
Builder: IVB �ll; - QA( 2 11.16.
THE FOLLOWING OORRECTIONS ARE REQUIRED:
aco
Inspector-� �v � _ _. --
_l -- Date,:,._!-__2— _t_—
DISAPP-LOVED -_ <APPROVISD SuBJlSCT Ti) ABOyL►
For Re 1.
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jNSpL*("TION
city or Tigard Building Departnwwt
13155 SW HalI Blvd. Tigard, Oregon 97223
Inepocti.on L!ne (ROC-0-Phone): 639-4175 Bus'.neas �-4171Phones
Inspections
Footiny Plbg. Undorelab Mach. Rough-in Appr/Rdwlk
Found. Plbg. Top Out Gas Ltns FIN)i.s
rA
Post/Beam Strnct. sari. Sewer Framing -Bldg.
Post/Ream Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Line Gyp. Bd. -IlBdl1•
[tate Requeateds Time: _______AM �P)M
Address.�13/� r' a \°C P.smit #1 1 r
Builders
THE FOLLOWING CORRECTIONS ARF. REQUIRED:
i
7!nspectors Dates 2
APPROVED DISAPPROVED APPROVRD sunineT To ABdVR
Call For Reinsp.
- ............: ........... ... i , ..,:,...-1•s....rc•MY;.St4YWWReNm01°iiM1MR,tX+Mr
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�Ns�cT�oN-NUT-.-�c$
city or Tigard Building Depsut—nt
19125 gm Ball Blvd. Tigard, Oregon 97223
inspection Line (P.ec-O-Phone): 639-4175 Business Pho a 9-4171 r
Insloction: _ ---
Footing Plbg. Underelab xwh. Rough-in appr/sdwlk
Found. Plbg. Top Out Oar Line FINAL:
Post/Beam Struct. San. Sewer lrming -Bldg.
Post/Ream Mech. Rain Drain �nr4lationn -Plumb.
Pibg. Underfloor Nater LineOGyp. !d. -Hoch.
-Z - r 1 Tilef J1M 1 l pH
Date Requw/fetede n^
hddresa: 1��77(0 1"14 f( I 4\ l7� Permi�tl, f /�l_Z
Builder"I Iyy� It A- '1 U 1 1 (�Jlu _
"m FOLLONINC CORRECTIONS ARE REQUIRND:
I
Inapactoc:_ / Datef "
APPROVED DISAPPROVED APPROVED SUBJECT TO AM
Call For Reinrp.
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LKU_&,TI0N NOT?CE
Cit of Tigard B;A.ldinq Departumt
13125 IM Ball Blvd. Tigard, Oregon 972
Inspection Line (Rea-O-Phone): 639-4175 Business o s 39-4171
Inspection: 4O
Footing Plb�i. Underslab Ntaoh. Rough-in Appr/Sdwlk
Pound. Plbg. %,vp t Gas Line FINAL:
i
Post/Beam Struct. San. Sellar healing -.Bldg. i
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line 3 Gyp. Bd. -Nech.
Dnr_e Requ�eysted: (�n, f / - 17 �Times Am pm
f
L'C a_ 1/ XQ� MS c,5 y
Add:^crent �_moo � � Paimit
flu Ider: 1 �_ t\,-, �.i 1- Q-'Y ( U I � V
THE FOLLOWING CORRECTIONS ARIL REQUIRRD:
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Inspectort Datet-L_-
�- �PROVZD DISAPPROVZD APPROVED SUBJECT TO ABOVE
Call For Reinap.
L.� 1rirJ
•
INSPECTION NOTICE
City of Tigard Building Department
13125 SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-7',�
ne)t 639-4175 Business Phone: 639-4171
Inspection: ,n ` --- r
Footing Plbq. Underelab Hoch. Rough-in ApFr/Sdwlk
Found. Plbg. Top Out Lias Line FINAL:
st Beam Str3C«.�- San. Sewer Framing -Bldg.
�--
�; am Koch. / Rain Drain Insulation -Plumb. I
Plbq. Underfloor Water Line Gyp. ed. -Meeh.
Date Reque
s
ted: L� L14 Tia�t ----Am-2.3
T _ P14
2.3
Address: X �?4� �D �? Permit it -!S I
y� �l __7 Q L/_J-1-14d
Builders__ LL1- �_
THE FOLLOWING CORRECTloNS ARE REQUIRF.Dt
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Inspectors
APPBOM DTSAPPROVED P.PPROVED SUBJECT TO ABOVE
call For Reinap.
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'ASFBCTLON NOTICE
City of Tigarc: Building Departosat a
1.317.5 aw Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phons): 639-4175 Business Phone: 639-4171
Inspection:
Posting Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Pound. Plbq. Top Out Cas Line FINAL:
Post/Be'xm Struct. C---Mn. Framing -Bldg.
Post/Beam Hoch. <lin Drai Insulation -Plumb.
Plbg. Underfloor ate 1 Gyp. Sd. -Mach. YY
Date Requested:_ Times - 1N �(�_PM
-Z
Address: l5.� '� 1�/��'YLP l Permit f s J lJ
Builder: �t�'�- �W z(t.,).'
THE FOLLOWING CORRECTIONS ARE REQUIREDs
I
Inspect r: Date s
APPROVED DTSAPPROVRD APPROVED SUBJECT To ABOVE
Call For Rainap.
wl, ,�F'��.� y. rs* s�!(a"�p la:'�nry'rlrt� •:"Pi tr' "TAIw'Y�'�s� Pi "'1Y°��g"- �''"���l�A�;�R�'�d 11,i,; 'I�Yiiilpll�� II I�
.,..,�,�.......,.......�..., .��+ roe'"
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_.N NOTICE
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Building Dep—t-ent
Blvd. Tigard, Gregoa 97223
Inspection Lina ttuw.-P-Phone): 639-4175 Business Phone: 639-4171 p
IRepectieR: T I e
Footing plbg. Undez�leb !ech. Rough-in Appr/Sdwlk
h
Found, pibg. Top Out Gas Line A*NALs e>•
at/I- San. Sewer Framing -Bldg.
Roam Kwh. Rain Drain Insulation -plumb.
Plbq bnderll Nater /Line Gyp. Bd. -Hoch.
Date Requestedt 1 I I y TidMt A!t _PM1i�
! c
Addreses �W �. Certoit t,�
Builders /
1 2 p.
Ytt.•� t,�.�__._. r-
THE FoLLow1NG COMMONS ARE REQUIRED: � �rP- 4'
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Inspectors Dater
APPR(MV DISAPPROVED APPROVED SUBJECT TO ABOVE
Cell For Rainap.
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INSPECTION NOTTCE ,..
City of Tigard Building Depax-t—nt d
13125 8W nal: Blvd- Tigard, Oregon 97223
Inspection Line (ROC-0-Phone), 639-4175 BusineAs Phone: 639-4171
Inspection:
Footing Pl.bg. Underslab hwh. Rough-in Appr/Sdwlk
mound. , Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Past/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -
G� �
Date Requested: _Timet i
Addresas_1�7 � 1 �1 ',ett , Permit 4s��7�
Builder: 1 Ylr.. ILI -29LS
TRE FOLLOWING OORREOTIONS ARE REQUIREDs
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Inapaotor:__V ( `/ t,-- Date -
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AP
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ROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
v( Call For Reinep.
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INSPECTION NOTICE
City of Tigard Building Depar meat VJ
13125 SR Fall Blvd. T19ard, Oregon 9723 �.
Inspection Line (Rec-O-thonp)s 639-4175 Business Phone: 639-4171
Inspeoti0n8
Footing- i Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Ream Struct. San. Sewer Framing -Bldg. .�.
Post/Deas Hoch. Rain Drain Insulation -Plumb. ' Q�
-Io
Plbg. Underfloor Nater Line Gyp. Rd. h. )
Date Requested:_f Time$ �1, AM PM
Address: �� i� 1 1 l{ b� C Permit 15T 0 qSl`I`�
Builders
THE FOLLOWING CORRECTIONS ARE RSQUIRtDi
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Inspector: ,` / Dates J}V J r
APPRDIRD DISAPPROVED ROVED SUBJECT TO ABOVE ���
Call For Rainap. z4 v 1
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PLUM
AL
�r./�TY OF TIGARD PERMIITIV#` . .. . I. MST93--9599 `i.
GOMMUNITY DEVELOPMENT DEPARTMENT DPT'E. I SSUE1): 12/16/93
13125 SW Hell Blvd.Tigard,Orogon 97223.8199 (503)839.4171
PARCEL: 2c 102CC--FF'004
SITE: ADDRESS— :. : 08536 SW MERLYNE CT �
SUBDIVISION. . . . : FINLEY PARK ZONING: R-7
BLOCK. . . . . . . . . . . LOT'. . . . . . . . . . . . . :004
CLASS' OF WORT;. . :NE14 GARBAGE DISPOSALS. .. : 1
TYPE: 01: USE. . . . :SF WASHINU MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . :0
OCCUPANCY GRP. R3 FLOOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . :0
i STORIES. . , . . . . . : 1 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :0
R
FIX TURES-_-- ----- -- - LAUNDRY TRAYS. . . . . . :0 SF PAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . : 1 GREASE_ TRAP'S. . . . . . . .0 ( '-'
LAVATORIES. :2 OTHER FIXTURES. , . . . :0
i
TUB/SHOWERS. . . . : SEWER LINE: (ft ) . . . . -0
1 WATER CLOSETS. . :2 WATER LINE; (ft ) . , . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft) . . . . :0
Ramarks : PATH B
OWNER: --_ _________._______.___---___•_- _------.__.__------_
FEES.-_---__.____.____
T'Irri MILLER TTF t 15;_0, 00 JH 12/16/93 -
13027 SW TIMARA LN BPRT $ 352. 0o JI.1 12/16/93 -• i
BPLC $ _28. BO JLH 12/1.3/9.3 93-••246585
TIGARD OR 97224 B5PC $ 1.7. S0 JH 12/16/93 --
Phone #: 598-8574 GSDC ? 280. 00 JH 12/16/93 -
PARK $ 500. 00 JH 12/16/93 -
Plumbing Contractors-------------- ...__.__ MPRT $ 40. 50 JH 12:/16/93 _
MPL'J $ 10. 13 JH 12:/16/93 -
Name : ,��� M5PC: $ 2. 0.3 JH 12/1.6/93 -
Address : _ PPRT $ 117. 50 JH 12/16/93
C i t Y _._._. 5t ate : _ P:JPC $ 5. 68 ,.1H 12/16/93
Z i P.- .____.Ph o n e#:
Reg
-------- REQUIRED INSPECTIONS
This permit is issued subject to the r,eg---
ulations contained in the Tigard Municipal Foot/found Insp Water Line Insp
Code, State of Ore. Specialty Code,, and all Post /Beam Strl_1ct Appr/Sdwlk Insp
other applicable laws. All work will be done Post/Beam Mechan Mechanical Final
in acr..;ordance with approved plans. Phis PLM/Underfloor Plumb Final
permit will expire if work is riot started Mechanical Insp Building Final
within 180 days of issuance, or if work is Plumb Top Out Erosion ConL-rol,
suspended for more than 180 nays. Framing Insp Crawl Drain
Fireplace Insp
Gas Line Insp _
/ > Insi_1l at i on lisp --
Gyp Boari Int p
Rain drain Insp
A thorized Pl _inbing Co,ltractor SignatIAre
Call for inspection - 639-4175
Contractor Notess
I
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT DEPAR_T`, T 1-DERMIT #. . . . . . . : M5•T93--•9595 i
13125 8W Hall Blvd.Tigard,Oregon 97223.911k3 03J'er99•�71 DATE ISSUED: 12.116/93
PARCEL: 2S102CC-FP004
;SITE ADDRESS. . . : 08536 SW MERLY14E CT
SUBDIVISION. . . . : FINLEY PARK ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :004
______._ BUILDINC3 _.___.____.-___.___.____._..--•--_.______._.______.__
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. :NEW BEDRMS:3 BATHS:2 GARAGE. . . . . . . . . . :450 sf
TYPE OF USE. . . :SF FLOOR REQUIRED SETBACKS--•___-_..--._-
TYPE OF CONST. :5N FIRST. . . . : 1392 sf LEFT. . :8 ft R I GH•T. :8 ft
OCCUPANCY GRID. :R3 SECOND. . . :0 sf FRONT. :20 ft REAR. . :24 ft
STORIES. . . . . . . : 1 THIRD. . . . :0 sf REQUIRED----------------------
HEIGHT. . . . . . . . :
-------_.._._--_--_-_-
HEIGHT. . . . . . . . : 16 ft TOTAL___._.__.-_-: 139E=. S f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . f : 72132 PARKING SPACES. . : 1
Remarks: PATH 8
PLUMBING _-._-------------_.-___-----------------
SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :2 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUB/SHOWERS. . . . :2 I.-OUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . -2 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
D I SHWASHERS. . . . : 1 WATER LINE (f t ) . : 100 OTHER FIXTURES. . . . . :0
k . GARBAGE DISF'. . . : 1 RAIN DRAIN (ft ) . :0
WASHING MACH. . . : 1 SF RAIN DRATNS. . : J.
-------- MECHANICAL ______..-----_.______________._._._._____-_. FEES
FUEL TYPE,__-__.-._._-_..--__. UNIT HTRS. . ;0 type amol..mt by date rer_pt
/GAS/ / / VENTS . . . . . :0 TIF $ 1520. 00 JH 12/16/93 -
MAX INPUT:O 8TL1 VENT F7AN5. . : 3 BPRT $ 352. 00 J1i 12/16/93 -
FURN ( 100K . . : I HOODS. . . . . . : 1 SPLC $ 228. 80 JLH 12/13/913 93-.2:46505
FURN ) =100K . . :0 WOODS•TOVE 3. :0 B5PC $ 17. 60 JH 12/16/93 _
FLOOR FURN. . . . :0 CLO DRYERS. : 1 SSDC $ 280. 00 JH 12/16/9;3 -
BOIL/CMP l :3HF':0 OTHER UNITS: 1 PnRK $ 500. 00 1I-1 12116/93 -
GAS OUTLETS: 1 MVIRT $ 40. 50 JH 12/16/93 -
Owner: -----.__ ._.__..-----...__ MPL.0 $ 10. 13 JH 12/16/93 -
TIM MILLER M5PC $ 2. 03 JH 12/16/93 -
13027 SW T I MARA L.N pPRT $ 117. 50 JH 12/16/93 -
P5PC $ `i. 88 JH 12/16/913
TIGARD OR 97224
Phone #; 598--8574
Contractor: ___..__-_--_-_--___.__----___-_-.._
TIM MILI__ER
13027 SW T [MARA LN
TIGARD OR 97,224
Phone #: 598--8574
Reg #. . 64687 ------__-._-_____------_•--_________________..____
! 3074. 44 TOTAL
This permit is issued subject to the regulations contained in the ------- tFQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore, Specialty Codes and all other Foot/fol_rnd Insp Gas Line Insp
applicable laws. All work will be don! in accordance with approved Past/Beam Strur_t Ins'.11ation Insp
plans. This permit will expire if work not started wit Be Post /Beam Meehan Gyp Board Insp
days of issuance, or if work is suspendd for more an S. PLM/Underfloor Rain drain Insp
J Mechanical Insp Water Line Insp
'ermi+:tee signat:t_tre: , F'li.rmb Top Oi_rt Appr/Sdwlk Insp 4
Framing Insp Mechanical Final
is:, -ted By : Fireplace Insp Pll..lmb Final
C;al1 for inspect; iori - 639-4175
•
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CITY OF TIGARD SEWER CONNECTION
PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . .. SWR93•--0517
13125 SW Hall Blvd.Tigard,Oregon 97223.81&3(iM' 74171 DATE_ ISSUED: 12/16/93
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PARCEL: 2S102CC-FP004
SITE ADDRESS. . . : OB 36 SW MERLYNE CT •
SUBDIVISION. . . . : FINLEY PARI; ZONING: R-7
BLOCK. . . . . . . . . . , LOT. . . . . . . . . . . . . :004
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : F I XTUPE UNITS- -
CLASS
RIITS. . . ;CLASS OF WORK. . . :NE:4 DWELLING UNITS. . : 1 f
'TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INF_.TALL TYPE. . . . :BUSWR IMPERV SURFACE. . : : sf
Remarks: PATH 8
Owner.: _.___.____-----________---------_.___._______---_._.__.___._.- FEES --------•-------
'TIM MILLER type amoa.lnt by date recpt
13027 SW TIMARA PRMT $ 2200. 00 JH 12/16/93 -
I NSF=' t 35. 00 JH 12/16/93 -
TIGARD OR 97224
Phone #: 598-•-8574
a
Contractor:
CONTRACTOR NOT ON FILE
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------------------------------------------
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Phone #: $ RE35. 00 TOTAL
7 Req #. . .
_-- - - REQUIRED INSPECTIONS --------
This Applicant agrees to comply with all the rules and regulations Sewer Inspection __ +
of the Unified Sewage Agency. The permit expires 188 days from _
the date issued. The total amount paid will be forfeited if the �^
permit expires. The Agency does not guarantee the accuracy of the _ r
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located thR nstaller shall pur as
a "Tap and Side Sewer" Permit and ti . A cy will inst a
Permittee Signatre:
T S 5 1_i e d By :
Call for inspection 639-4175
T
/ /
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PLNCK f ECT # n
� ? r ll12S5W Hall Uh�d. /
CITY Or rIGARD 1ips Oregon 97223 PERMIT #
COMMUNITY DE-VELOI MENT DEPARTMENT
(503)639-4171DATE ISSUED
JOB ADDRESS: TAX MAP/LOT
SUB: /A'-� {' `` ek LOT: LAND USE:
I
" VALUATION: = �` - y 7
SPECIAL NOTES
1 •
NAME: REISSUE OF:
i ADDRESS: _ LAST REISSUE:
FLOOD PLAIN/
PHONE: _ — SENSITIVE LAND: _—
CONTRACTOR APPROVALS REOUIRED
NAME: % kI //-ev 6045 t PLANNING: —
~-
ADDRESS: ,w, n!ACh� ENGINEERING:
� � G - -- ----
�_r, &u�e'� �j'/'v� _ — FIRE DEPT: —_
PHONE: 'r `� r ry _ OTHER:
iCONTR. BOARD #: �.car Le 7 �/" EXP DATE:
S "-f" ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: Xew I,(j LIST/SUBCONTRACTORS: __—
MECH: C ILtq55 Hr C, r' BUS TAX: -- _ —
ARCH/ENGINEER
CALCULATIONS: —
NAME: TRUSS DETAILS: _
ADDRESS: OTHER: _
PHONE:
PROPOSED BLDG. USE:
A
COMMENTS:
_lam` Trete r .� jfw
I�HE
APPLICANT SIGNATURE
Received By: - _-_- Date Received:
f
4
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE !
f
m7S� 10-432 00 Building Permit Fees 3J-v _ ?
10-431 00 Plumbing Permit Fees 7 '� _
10-431 01 Mechanical Permit Fees go
10-230 01 State Building Tax (5%)
Building
w
PIunit)ing
1 Mechanical
10-433 00 Plans Check Fee �_,Ls�L.z �� Z� f 0
j Building
Plumbing
Mechanical `10"i '3
f10-230 06 Fire —
I
30-202. 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees _
�"'
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
i
25-448-01 Residential Traffic Fees v
25-448-05 Mass Transit TIF Fees _.1_1_ 11�__.
52-449 00 Parks System Dev Charge (PDC) S S o
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) E
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
nm/3587P.W1'F
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"I 1 GORI) RLC_E•.1 F'T OF PAYMENT RE•GE I PT NO. tt 9 -'—,246,246!'16
CHECK AMOUNT tt 50°59. 44 �
J('IMf
MILLER, TOM CASH AMOUN-f 0. 00
aI.)I)RF":rif-r M•'NYMFNT DATE tt lig'/16/93
4 upAr)IV.(S.(ON l
JURPOSEE OF PAYMFN•T AMI]UNT PAI 1) PURPOSE OF PAYME:N'I" AMOUNT PA 10
+!!T l_5[NCJ f+F f2M �__....._. ;.3`w . 00 RI...UMH I NG PERM 1 t 7. 1150
41 C;NAN I CAL VIF 40- 50 S,r. BUILT) PFR
,i ,AN I:;F•CFXK FF -11. 07 9 .WE:R USA r"�'i?V.s0. VCU
`
1 WI :F2 1N'TFF�E(.^,f :315. 00 PARKS, �;UC: 0111. NVQ
�'LV. �V141 N. h1
iIORM DRAIN SDC F �
4-0,',3 i "I RAN S 1 F 1 1 F F=F=..h S 1 1 x11. 00
C
rl r 4 F 1NL:..V PARK
CSW MERLYNK 1..,1
,y
mint- AMOUNT PAID ._•. - > ''�V�`:'".{. 44
C:;1'I Y lit "f J(iWFtl.1 - ftF:.l:f I F'J 11F PAYMF-I'd I Ft1 (_:F.. 1 F'T Nl,l. v,93--P0,14-35
r ?�
AMCJUN T 0111 i
rJ(IME: 'TOM M I L.L..E W BU I LI)f:R INC' C Fa{..>ii AMOLIN'T a 0. 00
id.)f)RIy!~S t P0011 N1 DAIF c Ii!l1;3/917,
!)U411)'CVIS(ON s
r'I JRPC113E OF CSG+YMENT Al+1(KINT PAID F-'I_Ifil'C'I;ik: OF V"AYMEN'T AM111)N I F'10.(1)
I 'I .(af,J C;FCfcl";Ft FE 1 c'.. t F=llt "5tA» 00 WF:C K f'•f-. I p—l 4 H so. 0U
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